International Practice Variation in Post-Tonsillectomy Hemorrhage: A Survey Study of Pediatric Otolaryngologists

Abstract

Background: A significant complication of pediatric tonsillectomy is post-tonsillectomy bleeding (PTB). Management within and outside of the operating room (OR) is not standardized. We consolidated international similarities and differences in PTB management. Methods: This cross-sectional survey study was conducted from April 4 to May 16, 2024. It involved a 55-item questionnaire distributed online to a sample of pediatric otolaryngologists from 22 countries, and is a part of larger study on tonsillectomy. The study achieved a 38.2% response rate (112 of 293). Eligibility included proficiency in English and currently practicing pediatric otolaryngology. Results: A tonsil bleed was defined by 49.2% as any bleeding presenting to the hospital. In all, 58.3% signified taking patients for operative management in the presence of active bleeding. Operative criteria included persistent bleeding on presentation, repeated bleeding while admitted, severity, signs/symptoms of anemia or hemodynamic instability, or age less than 3 and non-cooperative. When treating PTB within the OR, bipolar cautery is used by 60.6%. In all, 57.3% admit all patients experiencing a PTB for 23-h observation versus 21.2% who admit a subset of patients for 23-h observation. In all, 47.7% indicated that they have a formal monitoring program for bleeding rates in their institution/practice. Readmission rates are monitored by 60.7% of respondents. Conclusion: There are no standardized best practices for PTB. Our study confirmed moderate numbers of formal monitoring programs, and varying clinical decision rules when defining a tonsil bleed, readmitting a PTB, and management within or outside of the OR. Understanding global variation may facilitate development of future clinical practice guidelines.